Effect of Sanction/Remedy on Patients Admitted before the Effective

10006.3 - Effect of Sanction/Remedy on Patients Admitted before the Effective Date of Sanction/Remedy (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) The patient’s status on the effective date of the suspension of payment sanction/remedy is the controlling factor. This sanction/remedy would not apply to patients who have been receiving care from the HHA or hospice program before the effective date of this sanction/remedy. This sanction/remedy would apply only to new Medicare admissions. CMS will suspend payments for new Medicare patient admissions to the HHA or hospice program that are made on or after the effective date of the imposition of the sanction/remedy for the duration of the sanction/remedy. Payments for individuals who are already receiving services could continue. CMS defines a “new admission” as the following: • A patient who is admitted to the HHA or hospice program under Medicare on or after the effective date of a suspension of payment sanction/remedy; or • A patient who was admitted and discharged before the effective date of the suspension of payment and is readmitted under Medicare on or after the effective date of suspension of payment sanction/remedy. As part of this sanction/remedy, the HHA or hospice program would be required to notify any new patient admission, before care is initiated, of the fact that Medicare payment would not be available to this HHA or hospice program because of the imposed suspension. The HHA or hospice program would be precluded from charging the Medicare patient for those services unless it could show that, before initiating the care, it had notified the patient or representative both orally and in writing in a language that the patient or representative can understand that Medicare payment is not available. The suspension of payment sanction/remedy will end when CMS finds that the HHA or hospice program is in substantial compliance with all the CoPs or when the HHA or hospice program is terminated. That is, the suspension of payment sanction/remedy would end when the HHA or hospice program has corrected all condition-level deficiencies, and the correction has been verified by the SA. Any Medicare patients admitted during the suspension of payment period would require a new start of care (SOC) date after the suspension of payment for new admissions has ended. This is required for the HHA or hospice program to begin receiving payments for those patients.